Title: MrMrsMsMissDr / Name:
Job Title: / BAND (Trust staff only)
Organisation: / Directorate (Trust staff only):Acute ServicesMedicalTrust BoardChief Executive OfficePerformance/ReformChildren ServicesOlder People/Primary CareHR/Organisational DevelopmentMental Health/DisabilityFinance/Procurement
Type of Organisation: StatutoryVoluntaryCommunityIndependentSmall/Medium Business / Profession/Role: Admin/ClericalAncillary/generalCarerClergyChildcare Leisure servicesNurses/Midwife/HVProfessional/techSecurity/Emergency ServiceSocial careTeacherVolunteerYouth/community workern/a
Line Manager approval given: YesNo / Line Manager name: (signature not required)
Address:
Postcode:
Contact Phone Number:
Contact Email Address:
Do you consider yourself to have a disability? YesNo If yes any specific requirements e.g. assistance on arrival, sign language, interpreter, materials in large print etc:
Course Details
Name of Course: ASISTB+Blind Cord SafetyBoccia Leader TrainingBOUNCECarbon Monoxide WorkshopCBTChair Based Exercise Level 1Child Safety in the HomeCommunity Dev AwarenessCompassion Fatigue, Self-Care and Workplace WellneCycle Leader TrainingEarly MoversEngageHead First at WorkHIV Awareness TrainingIdentifying Fire Risk Among Vulnerable Clients/PtsLeading Creative Movement, Dance with Older PeopleMental Health First AidMood MattersPreventing Poisoning Accidents - Children/babiesReview Relax RenewRisks to Older People in the HomeVolunteer Walk Leader training
Date(s) of Course:
Venue of Course:
It is essential to complete this sectionto demonstrate how this training can be utilised, this information will be used for allocation of places on courses. Failure to complete this information may mean that you will not be considered for a place
Intended target group/s? / Start date for programme/implementation of training / Anticipated no. of sessions/year & frequency / Anticipated no. of participants
Older PeoplePeople with a disabilityParents/familiesChildren aged 0-5Young People 6-18WomenMenBME/TravellerCarersPre/post natal womenVolunteersmental healthpatients/clientsworkplace/colleaguesand/or (if required) Older PeoplePeople with a disabilityParents/familieschildren 0-5young people 6-18womenmenBME/TravellersCarerspre/post natal womenVolunteersmental healthpatients/clientsworkplace/colleagues / 1-56-1011-1516-2020+part of daily role / 1-56-1011-1516-2020 +Caseloadpart of daily role
- Confirmation of your place will be sent to you prior to the start date of the course. Only attend if you have received this confirmation.
- Please note that there will be no hospitality provided at any of these courses.
- In the interest of ensuring appropriate and efficient use of public funds, it is essential that course participants attend the times as outlined in course programme. All cancellations must be made by email to or by phone to 028 37 412406
Please note that all non-attendees will be notified to their Line Manager